Effect of Olmesartan on Left Ventricular Hypertrophy in Hypertensive Patients

Abstract

Objective: Detection of left ventricular hypertrophy (LVH) regression with antihypertensive treatment in hypertensive patients is associated with decreased risk of cardiovascular disease. Angiotensin receptor blockers (ARBs) that were decreased left ventricular hypertophy in hypertensive patients. In this study, we aimed to investigate the effect of olmesartan on LVH in hypertensive patients. Method: In this study we enrolled hypertensive patients whom have LVH. 16 patients received olmesartan 20 mgr/day and 16 patients received atenolol 50 mgr/day. Echocardiography was performed at the begining and in the first and sixth month. Left ventricular mass index (LVMI) were calculated using Devereux Formula. Results: In the olmesartan group, initial left ventricular mass index (LVMI) was 127.7 ± 21.8 g / m2, 124.2 ± 19.7 g / m2 in the first month and 107.3 ± 17.2 g / m2 in the sixth month. The initial LVMI in the atenolol group was 128.7 ± 24.2 g / m2, 128.3 ± 24.2 g / m2 in the first month and 123.1 ± 22.7 g / m2 in the sixth monthThere was no significant difference between LVMI in both groups at baseline and at 1 month. LVMI regressed more in the group receiving olmesartan in the sixth month ( p= 0,034). Conclusion: LVMI regressed significantly in the group receiving olmesartan at the end of the 6th month. The decrease in LVMI in Olmesartan group suggests that ARBs have molecular effect besides blood pressure decrease.

Keywords

• Hypertension,Left ventricle hypertrophy

Hipertansif Hastalarda Olmesartan’ın Sol Ventrikül Hipertrofisi Üzerine Etkisi

Öz

Amaç: Antihipertansif tedavi ile sol ventrikül hipertrofisi (SVH) gerilemesi saptanması kardiyovasküler hastalık riskinde azalma ile ilişkilidir. Angiotensin reseptor blokerleri (ARB) hipertansiyona bağlı SVH’ ni geriletmede etkili ajanlardır. Biz çalışmamızda olmesartan’ın SVH üzerine etkisini araştırmayı amaçladık. Metod: Çalışmamıza SVH olan hipertansif hastaları dahil ettik. Çalışmaya 16 olmesartan 20 mgr/gün ve 16 atenolol 50 mgr/gün alan hasta dahil edildi. Ekokardiyografi tüm hastalara başlangıçta, 1. ve 6. ayda uygulandı. Sol ventrikül kütle indeksi (SVKİ) Devereux formülü ile hesaplandı. Bulgular: Olmesartan grubunda başlangıç SVKİ 127,7 ± 21,8 gr/m2, birinci ayda 124,2 ± 19,7 gr/m2 ve altıncı ayda 107,3 ± 17,2 gr/m2 olarak bulundu. Atenolol grubunda başlangıç SVKİ 128,7 ± 24,2 gr/m2, birinci ayda 128,3 ± 24,2 gr/m2 ve altıncı ayda 123,1 ± 22,7 gr/m2 olarak bulundu. Her iki grup SVKİ değerleri arasında başlangıçta anlamlı fark yoktu. 1. aydaki iki grup SVKİ’ i değerleri arasında anlamlı fark saptanmadı. 6. aydaki SVKİ arasında olmesartan lehine istatistiksel olarak anlamlı fark tespit edildi. ( p= 0,034). Sonuç: İki grup arasında SVKİ’leri 6.ay sonunda olmesartan alan grupta anlamlı olarak daha fazla geriledi. Olmesartan grubundaki SVKİ deki azalmanın kan basıncı düşürmesinin yanında ARB’lerin moleküler etkisi olduğunu düşündürmektedir.

Anahtar Kelimeler

• Hipertansiyon

Kaynakça

1. Referans1.European Society of Hypertension-European Society of Cardiology Guidelines Committee. 2003 European Society of Hypertension-European Society of Cardiology guidelines formanagement of arterial hypertension. J Hypertens 2003;21:1011-53.
2. Referans2. Levy D, Garrison RJ, Savage DD, Kannel WB, Castelli WP. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med 1990;322:1561-6.
3. Referans3. Verdecchia P, Schillacci G, Borgioni C et al. Prognostic significance of serial changes in left ventricular mass in essential hypertension. Circulation 1998;97:48-54.
4. Referans4. Okin PM, Devereaux RB, Julius J et al. Regression of lectrocardiographic left ventricular hypertrophy by losartan versus atenolol. The LIFE Study. Circulation 2003;108:684-90.
5. Referans5. Okin PM, Devereaux RB, Julius J et al. Regression of electrocardiographic left ventricular hypertrophy during antihypertensive treatment and the prediction of mayor cardiovascular events. JAMA 2004;292:2343-9.
6. Referans6. Verdecchia P, Angeli F, Borgioni C et al. Changes in cardiovascular risk by reduction of left ventricular mass in hypertension: a meta-analysis. Am J Hypertens 2003;16:895-9.
7. Referans7. Mathew J, Sleight P, Lonn E et al. Reduction of cardiovascular risk by regression of electrocardiographic markers of left ventricular hypertrophy by the angiotensin converting enzyme inhibitor ramipril. Circulation 2001; 104:1615-21.
8. Referans8. Schneider MP, Klingbeil AU, Delles C et al. Effect of irbesartan versus atenolol on left ventricular mass and voltage: results of the CardioVascular Irbesartan Project. Hypertension 2004;44:61-6.

9. Referans9. Dahlöf B, Devereux RB, Kjeldsen SE et al. Cardiovascular morbidity and mortality in the Losartan Intervention for Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet 2002;359:995-1003.
10. Referans10. Klingbeil AV, Schneider M, Martus P, Messerli FH, Schmieder RE. A meta-analysis of the effects of treatment on left ventricular mass in essential hypertension. Am J Med 2003;115:41-6.
11. Referans11. Cuspidi C, Muiesan ML, Valagussa L et al. Comparative effects of candesartan and enalapril on left ventricular hypertrophy in patients with essential hypertension: the candesartan assessment in the treatment of cardiac hypertrophy (CATCH) study. J Hypertens 2002;20:2293-300.
12. Referans12. Devereux RB, Dahlöf B, Gerdts E et al. Regression of hypertensive left ventricular hypertorphy by losartan compared with atenolol. The Losartan Intervention For Endpoint reduction in hypertensive (LIFE) Study. Circulation 2004;110:1456-62.
13. Referans13. Malmqvist K, Kahan T, Edner M et al. Regression of left ventricular hypertrophy in human hypertension with irbesartan. J Hypertens 2001;19:1167-76.
14. Referans14. Verdecchia P, Angeli F, Achilli P, Castellani C, Beroccatelli A, Gattobigio R, et al. Echocardiographic left ventricular hypertrophy in hypertension: marker for future event or mediator of events? Curr Opin Cardiol 2007;22:329-34.
15. Referans15. Redon J, Fabia MJ. Efficacy in angiotensin receptor blockade: a comparative review of data with olmesartan. J Renin Angiotensin Aldosterone Syst. 2009;10(3):147–56.
16. Referans16. Lukman LF,Berk LS,Tan LG, Tan SA: Losartan regresses left Ventricular hypertrophy and improves ejection fraction in hypertensive diabetic patients. Chest1996;110(suppl):109S.
17. Referans17. Bignotti M, Ameti L, Barberi D, etal: Effects of chronic treatment With the angiotensin II antagonist losartan on leftventricular anatomy and function and microalbuminuria in hypertensives(abst). J Hypertens 1997;15(suppl4):S128.
18. Referans18. Paraskeupoulou E, Serpentis I, Stud M, Tsingkas D: The effect of Antihypertensive treatment with an antagonist of angiotensin II on the Structural characteristics of the leftventricle(abst).
19. Referans19.Himmelmann A, Svensson A, Dahlo ¨fB, Bergbrant A, Hansson L: Losartan in essential hypertension: effects on blood pressure and left Ventricula rmass. High Blood Press1995;4:242–248.
20. Referans20.Villatico-Campbell S, Rizzo V, DiMaio F, etal: Antihypertensive Therapy with losartan and fosinopril: efficacy in leftventricular Hypertrophy regression (abst). Am J Hypertens 1998;11:125A.
21. Referans21.Tedesco MA, RattiG, Aqunio D, etal: The effectiveness and Tolerability of losartan and effect on leftventricular mass in patients With essential hypertension. Cardiologia 1998;43:53–59.
22. Referans22.Tedesco MA, Ratti G, Aquino D, etal: Effects of losartan on Hypertension and leftventricular mass: a long-term study. J Hum Hypertens 1998;12:505–510.
23. Referans23.Dahlof B, Devereux RB, Kjeldsen SE et al. Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet 2002; 359:995-1003.
24. Referans24.Thurmann PA, Kenedi P, Schmidt A, Harder S, RietbrockN : Influence of the angiotensin II antagonist valsartan on left ventricUlar hypertrophy in patients with essential hypertension. Circulation 1998;98:2037–2042.
25. Referans25.Malmqvist K, Edner M, Kahan T, Nys M, Triscari J ,Osbakken MO: Correlation of left ventricular hypertrophy and pulse pressure after 48 weeks of therapy with irbesartan and atenolol. Circulation1998; 98(supplI):I-2914–I-2915.
26. Referans26.Mitsunami K, Inoue S, Maeda K, etal: Three-month effects of Candesartan cilexetil, anangiotensin II type1 (AT1) receptorantagonist, on leftv entricular mass and hemodynamics in patients with essential hypertension .Cardiovasc Drugs Ther 1998;12:469–474.